What are the treatment options for knee catching after total knee replacement?

Treatment Options for Knee Catching After Total Knee Replacement

The primary treatment approach for knee catching after total knee arthroplasty should begin with plain radiographs to assess component positioning and alignment, followed by appropriate diagnostic imaging based on suspected cause, and targeted interventions that may include physical therapy, arthroscopic debridement, or component revision depending on the underlying mechanism. 1

Initial Evaluation

• Plain radiographs (X-rays) of the knee should be obtained first in all patients with post-TKA symptoms like catching to assess component positioning, alignment, and potential complications 2, 1
• Clinical assessment should focus on differentiating between common causes of post-TKA symptoms, including:
  • Component malposition or rotation issues 2
  • Periprosthetic soft tissue abnormalities 2
  • Patellar tracking problems 3
  • Tibial-femoral instability 3

Diagnostic Imaging Algorithm

• For suspected component rotation issues (a common cause of catching):

  • CT scan without IV contrast is the imaging modality of choice (rated 9/9 for appropriateness) 2, 1
  • MRI without IV contrast may be considered as an alternative (rated 6/9 for appropriateness) 2

• For suspected periprosthetic soft tissue abnormalities (including patellar clunk syndrome or impingement):

  • MRI knee without IV contrast (rated 7/9 for appropriateness) 2
  • Ultrasound knee (rated 7/9 for appropriateness) 2

Treatment Based on Underlying Cause

Patellar Tracking Problems

• Often presents as catching or clicking during knee flexion and extension 3
• Treatment options:
  • Physical therapy focusing on quadriceps strengthening 1
  • Arthroscopic debridement for patellar clunk syndrome 4
  • Component revision for severe maltracking 3

Tibial-Femoral Instability

• May cause catching, giving way, or locking sensations 3, 5
• Treatment options:
  • Bracing for mild instability 1
  • Component revision for significant instability 3

Periprosthetic Soft Tissue Abnormalities

• Including quadriceps or patellar tendinopathy, arthrofibrosis, or soft tissue impingement 2
• Treatment options:
  • Physical therapy for mild cases 1
  • Arthroscopic debridement for persistent symptoms 4
  • In cases of recurrent hemarthrosis (which can cause catching sensation), options include immobilization, arthroscopic synovectomy, angiographic embolization, or revision arthroplasty 6

Pitfalls and Considerations

• Mechanical symptoms like catching should not be automatically attributed to osteoarthritis in the replaced knee; specific anatomical causes should be identified 4
• Patients with post-TKA mechanical symptoms often have specific anatomical abnormalities that can be addressed with targeted interventions 4
• Younger age, reduced knee proprioception, reduced sensory orientation, and greater knee pain are associated with higher fall risk after TKA, which may be exacerbated by mechanical symptoms like catching 5
• Return to sports and recreational activities is important for many TKA patients (85% return to some level of activity), but mechanical symptoms like catching can significantly impact this outcome 7

Follow-up Recommendations

• For patients with persistent catching despite initial management, consider referral back to the orthopedic surgeon for further evaluation 1
• Annual weight-bearing radiographs are recommended for detecting subclinical wear in the prosthesis, which could eventually lead to mechanical symptoms 1